2011 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Prescription Blue Option A (PDP) by Blue Cross Blue Shield of Michigan | ||||
State: | Michigan | ||||
Plan ID: | S5584 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-800-565-1770 TTY users 1-800-579-0235 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the Prescription Blue Option A (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $72.00 | ||||
Annual Deductible: | $145 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,840 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,773 drugs | Browse the Prescription Blue Option A (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $5.00 | $35.00 | $70.00 | 25% | 25% |
• Number of Drugs per Tier: | 1501 | 451 | 884 | 329 | 608 |
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Michigan: | 8,060 members (CMS Region 13) | ||||
Number of Members enrolled in this plan nationally: | 8,213 members |